Archived: Alston House

Alston House provides accommodation and personal care for up to 19 older people some of whom are living with dementia. It is located in Aylestone close to Leicester city centre. The service has bedrooms, some of which have ensuite facilities, on two floors accessed by a passenger lift and a garden at the rear. At the time of our inspection there were 17 people using the service.

The service has a registered manager. This is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us the staff were caring and kind. Staff communicated with people in a positive and compassionate manner. The atmosphere in the home was friendly and inclusive. People and staff listened to music together and one person enjoyed dancing with a staff member. Visitors were made welcome and staff spoke with them about how their family members were getting on.

Staff provided people with responsive and personalised care. Staff knew the people they supported well and understood their needs. We saw staff talking with people and making sure they had what they wanted. Staff told us that because their service was small they had the opportunity get to know the people they supported and how they liked things done.

All the people we spoke with said they felt safe at Alston House. Staff knew where people were at risk from falls or other accidents and took action to reduce the risk of harm. The premises were adapted to help keep people safe, for example people had call bells within reach and mobility and walking aids available to them. Staff were trained in safeguarding [protecting people from abuse] and understood their responsibilities to keep people safe.

People had mixed views about staffing levels at the service. Some people thought they were satisfactory whereas others felt there should be more staff on duty. Records showed staffing levels to be acceptable, given people’s needs, but the managers agreed to keep them under constant review and make changes where necessary to ensure people’s needs were always met in a timely manner.

People told us they had their medicines on time. Medicines were administered by trained senior carers. The managers carried out weekly medicines audits and took advice for their pharmacist and the local health authority to ensure people’s medicines were safely managed.

People said they thought most of the staff were well-trained. Staff completed a range of courses to help ensure they had the skills and knowledge they needed to provide effective care. The managers and staff had a working knowledge of the Mental Capacity Act and understood the importance of people consenting to their care.

People were positive about the food provided. We saw lunch being served on the first day of our inspection visit. The food appeared wholesome and well-presented. If people needed assistance or prompting with their meals staff provided this. The deputy manager carried out a monthly meals audit and made change to the menus in line with people’s wishes.

People told us staff supported them with their healthcare needs and accompanied them to appointments where necessary. People’s medical history and healthcare needs were documented in their care records so staff had the information they needed to help keep people healthy. Records showed people had access to a range of health care professionals including GPs, district nurses, chiropodists, and opticians.

People told us there were concerned about the lack of activities and outings at the service. They said this had left some of them feeling bored and unstimulated. Records showed activities were infrequent and mainly consisted of watching TV, listening to music, and board games. We have made a recommendation that the provider improves the service’s activities programme.

People said the managers and staff were approachable and friendly. Residents and relatives meetings were held every few months to get people’s views on the service. The managers carried out audits to help ensure the service provided good quality care in a suitable environment.

Although these were mostly effective, and had led to improvements, some issues with the premises had yet to be identified or addressed.

This inspection took place on 19 and 23 August 2016. The inspection was unannounced and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people and older people living with dementia.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager had delegated day-to-day management of the services to the deputy manager at the time of the inspection.

We carried out an unannounced inspection of this service on 10 August 2015. Three breaches of legal requirements were found. The provider had not ensured that people were protected against the risks of unsafe care being provided, people's consent and not always been sought in providing personal care to them and systems had not been effective in providing a quality service to meet people's needs. After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We checked that the provider had followed their plan, and to confirm whether they had now met legal requirements. We found improvements in these issues and these breaches had been rectified.

People using the service and the relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

Staffing levels were sufficient to ensure people were protected from risks to their safety.

People using the service and their relatives told us they thought medicines were given safely and on time and we found this to be the case.

The premises appeared safe with no tripping or slipping hazards observed, except for access to a storage area, which was then made safe on the day of the inspection visit, and a lack of side tables to place hot drinks on.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs, and we saw that more training was to be provided to staff so that they had the skills and knowledge to meet all of people's needs.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives. The service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink and people told us the food was satisfactory. People were assisted to eat when they needed help.

People's health care needs had been protected by referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way.

There was some evidence that people and their representatives were involved in making decisions about their care, though this needed to show that people and their representatives were involved in drawing up individual care plans.

Care plans were individual to the people using the service and covered their health and social care needs.

There were not always sufficient numbers of staff to ensure that people's needs were responded to in good time.

A comprehensive range of activities had not always been organised to provide stimulation for people.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

Not all people’s relatives were satisfied that their views had been acted on.

Management carried out audits and checks aimed to ensure the home was running properly to meet people's needs, though these had not always identified safety concerns.

We found people's privacy, dignity and independence were respected. One person told us 'the staff look after me well.' Another person told us 'everything is okay, I'm very happy here.' We found the provider had introduced an activities programme, and saw people using the service taking part in, and enjoying, activities during our inspection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

Although we found people's privacy and dignity were respected, we found that most people using the service had no opportunity to take part in any social or leisure activities.

We found people experienced care and support that met their needs and protected their rights. One person told us 'I like it here, the food is lovely and the staff look after me well." Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. People's medication was not always stored safely and securely. The number of controlled drugs in the controlled drugs cupboard did not match with the number recorded in the controlled drugs register.

Although there was a recruitment and selection process in place, we found that gaps in a person's employment history were not fully explained.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.